Index only scans work in some cases but not all. In order for an index only scan to be more efficient than a regular index scan, the visibility map needs to be up to date. This is a problem because (currently) the only thing that updates the visibility map is the vacuum and the autovacuum only runs after a large number of updates/deletes happen on a table. If your table is largely read/insert only, the only way to keep the visibility map up to date is to manually call VACUUM on your tables periodically which is a huge pain.